Are NICE and GIRFT recommendations for the management of acute ureteric colic achievable? A snap shot comparison of a tertiary referral versus district general hospital.
BAUS ePoster online library. Abboudi H. Jun 24, 2019; 259460; P1-15
Mr. Hamid Abboudi
Mr. Hamid Abboudi
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Abstract
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INTRODUCTION

NICE and GIRFT have recommended improved management of ureteric colic through definitive treatment within 48 hours in patients with uncontrollable pain or stones deemed unlikely to pass. We aimed to determine how feasible this is to achieve.

METHODS

Data was prospectively recorded for all acute colic presentations between 1st November–31st December 2018 in a tertiary referral unit and a DGH and evaluated against NICE 2019 and GIRFT recommendations.

RESULTS

Overall, 20 of the 52 patients (38%) with acute colic at the tertiary centre were potentially eligible for 48-hour treatment. 25% (5/20) of these were septic and therefore drained (4 stented, 1 nephrostomy) leaving 75% (15/20) suitable for active treatment of whom 60% (9/15) received definitive treatment within 48 hours (8 URS, 1 ESWL). Complete stone clearance was achieved in 66% (1 ESWL and 5/8URS cases); the other 3 URS cases were young men with failed access due to tight ureters. Of the 6 patients not treated within 48 hours, 4 underwent primary URS the following Monday. Lack of theatre time meant 2 patients had a temporising stent. By contrast 11 DGH patients were eligible for 48-hour management: 100% received an emergency stent and were still waiting for definitive management at the date of abstract submission.

CONCLUSION

Treatment within 48 hours is ambitious but provides a good outcome. The weekend effect is problematic, but 72-hour management is more realistic and seems acceptable. Dedicated theatre time and expertise (including over weekends) will be needed to meet the NICE and GIRFT recommendations.
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